Table 3:

Clinical and laboratory features of ketosis-prone diabetes5,25,27

Clinical considerationsLaboratory features
Unprovoked ketoacidosis often occurs; may be new-onset diabetesβ-cell antibodies present in up to 28% of patients25
Afro-Caribbean or Hispanic ancestryC-peptide often low or undetectable during diabetic ketoacidosis; recovery expected in > 60%
Periods of insulin independence interspersed with periods of acute insulin deficiency and diabetic ketoacidosisRatio of fasting C-peptide (nmol/L) to glucose (mmol/L) > 11 may be used as reliable predictor of insulin discontinuation27
Type 2 diabetes phenotype common (obesity, insulin resistance, metabolic syndrome)Presence of HLA alleles for type 1 diabetes associated with insulin dependence within 1–2 yr25
Fluctuating glycated hemoglobin (A1C) pattern consistent with β-cell failure and recovery
Male predominance among patients with unprovoked diabetic ketoacidosis (male–female ratio 2.6:1)5
Insulin should always be initial therapy, with reduction of cardiovascular risk factors5
  • Note: HLA = human leukocyte antigen.